Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
ReviewHybrid thoracoabdominal aortic aneurysm repair: concomitant visceral revascularization and endovascular aneurysm exclusion.
Thoracoabdominal aortic aneurysms (TAAA) remain a formidable surgical challenge, with conventional open repair associated with significant rates of mortality and morbidity. Furthermore, many of these patients are elderly with significant comorbidities and may not be candidates for repair. Consequently, the availability of a "hybrid" option, including open visceral debranching with concomitant endovascular aneurysm exclusion, may have advantages in these high-risk patients, including the potential to offer therapy to those ineligible for conventional repair. ⋯ In all cases, endovascular exclusion of the aneurysm has been performed at the same operation. The procedure is applicable to all types of TAAA (Extent I-V), although a bifurcated abdominal aortic endograft may be required if inadequate distal landing zone for a tube endograft exists above the aortic bifurcation. Results to date suggest this technique of "hybrid" TAAA repair to be a safe alternative to conventional repair for TAAA in older patients with significant comorbidity, with results in our institution similar to those previously published for younger patients undergoing conventional repair in high-volume centers.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
ReviewMultimodality strategies in malignant pleural mesothelioma.
Over the last decade, several improvements have been made in the diagnosis and treatment of malignant pleural mesothelioma, including better understanding of tumor biology, availability of more potent chemotherapeutic drugs, improved surgical management, and optimized multidisciplinary therapy. Radical tumor resection by means of extrapleural pneumonectomy (EPP) is now feasible with acceptable morbidity and mortality, even after neoadjuvant chemotherapy, if performed in specialized centers. To date, the best survival data have been reported after multimodality treatment strategies that include surgical resection. In this article, we discuss several strategies that involve EPP or pleurectomy/decortication in combination with various adjuvant and neoadjuvant therapies.
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Improving existing means of sentinel lymph node identification in non-small cell lung cancer will allow for molecular detection of occult micrometastases that may cause recurrence in early stage non-small cell lung cancer. Furthermore, targeted application of chemical and biological cytotoxic agents can potentially improve outcomes in patients with lymph node (LN) metastases. "Therapeutic Sentinel Lymph Node Imaging" incorporates these modalities into a single agent thereby identifying which LNs harbor tumor cells and simultaneously eradicating metastatic disease. In this review, we summarize the novel preclinical agents for identification and treatment of tumor bearing LNs and discuss their potential for clinical translation.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
ReviewEndovascular repair of blunt thoracic aortic injuries.
Blunt traumatic aortic injury is a highly fatal injury caused from rapid deceleration of the thorax. Most victims do not survive to obtain emergency medical care. Immediate open surgical repair had been the standard of care for decades, but more recent strategies and the emergence of thoracic aortic endografting have changed protocols for the treatment of this highly lethal lesion. This article reviews the current treatment of blunt thoracic aortic injury and the use of thoracic aortic stent grafting for this patient population.